Substance abuse and dependence is highly prevalent among people living with HIV and significantly exacerbates morbidity and mortality and accelerates HIV disease progression. Antiretroviral therapy (ART) has been the single most important treatment for slowing disease progression. ART adherence and HIV primary care are affected by a complex array of factors in the context of lives impacted by socioeconomic, psychological, and health challenges. Drugs and alcohol play a major role in non-adherence, engagement in care, and poor health outcomes among HIV-positive persons. While evidence is unequivocal that substance use treatment improves health outcomes, systems of care for the detection and treatment of substance abuse and dependence remain fragmented. Integrated approaches are key to the delivery of optimal care. Pragmatic or effectiveness trials can provide the best evidence about clinical practice to inform practitioners and policy makes about the most clinically and cost effective treatment to inform dissemination on a wider scale at the organizational and public health levels. We established a public-private partnership between public health investigators, clinicians and researchers within the City University of New York (CUNY), the nation's largest urban public university and the Institute for Advanced Medicine at Mount Sinai Health System, the largest provider of HIV medical care in the NYC area to nearly 10,000 HIV-infected persons from diverse backgrounds and from underserved communities. This collaboration will address implementation challenges at the frontline of service provision to pave the way for a comprehensive, integrated program to detect and reduce substance abuse and in turn, to improve ART adherence and HIV, substance use and associated health outcomes among HIV-positive individuals. We will achieve our goals through four specific aims: 1) develop an intervention to integrate substance abuse treatment with HIV care in a consortium of HIV clinics in New York City; 2) test the effectiveness of the intervention using a stepped wedge trial design to sequentially implement a screening tool and training of patient health navigators at six HIV clinics; 3) develop optimized technologies within the electronic health record (EHR) system used at the HIV clinics and integrate these with existing substance-use treatment mobile applications to retain patients in recovery and relapse prevention; and 4) assess the cost- effectiveness of implementing this organizational-level intervention. Our project has the potential to exert a sustained and powerful influence not only by providing data about the effectiveness of an organizational-level intervention to integrate substance abuse treatment with HIV treatment among HIV-positive individuals, but also on the effective use of EHRs that integrate treatment for both substance abuse and HIV care.